"Invisibility is a lack of hope, a lack of opportunity, and the inability to access the basic elements that define a safe, productive life, including education, health care, housing, food, clean water, sanitation, and security." - Invisible Children

Children Under Five

Despite recent decreases in infant mortality rates, the first 28 days of life remain the most perilous for the world’s most marginalized babies. In 2012 nearly 44 per cent of all under-five deaths occurred during the neonatal period – a staggering 2.9 million deaths a year, with about one million of those occurring in the first day of life.[i] Under-five mortality continues to claim the lives of children in poverty at alarming rates. In 2012, 6.6 million children died before their fifth birthday, a rate of twelve deaths per minute, or 18,000 each day.[ii] Since 1990, 216 million children have not reached the age of five - more than the current total population of Brazil, the world’s fifth most populous country.[iii] Death comes through various doorways, but preventable, curable diseases claimed roughly one-third of these children. Pneumonia killed more than 3,000 under-fives each day in 2012, constituting 17 per cent of all deaths and making pneumonia the single largest killer. Diarrhea and malaria followed close behind.[iv]

Major inroads have been made against longstanding pandemics such as polio and tuberculosis, thanks in large measure to both the financial investments and the multilateral coordination of the Bill and Melinda Gates Foundation. The End Polio Now campaign of Rotary International has been a vital partner in this effort as well, mobilizing awareness and support across the globe. And in spring 2014 the World Health Organization officially declared India, which as late as 2009 reported nearly half of the world’s total polio cases, to be polio-free.[v]

But despite these successes, polio is reemerging as a global health concern. Pakistan and Syria have confirmed cases, and the disease has crossed into their neighboring countries of Afghanistan and Iraq. Total global infections more than doubled between 2013 and 2014.[vi] As of August 2015, Africa has gone a full year without any recorded cases. This is a significant milestone thanks to the intensity of vaccination campaigns over the last several years, but experts remain cautious calling the situation ‘fragile’ due to the risk of unrecorded cases persisting in remote areas. The continent will need another two full years without incident before it could be declared Polio-free.[vii] Tuberculosis persists as a major problem in many countries, ranging from Vietnam, Myanmar, Kenya, Mozambique and the Democratic Republic of Congo (DRC), to stronger economies like India, China, South Africa and Russia.[viii]

Other less visible diseases, which have yet to be the focus of global eradication efforts, also take their toll. Congenital syphilis, which is passed from mother to child, is responsible for an estimated 500,000 deaths annually. That is slightly more than the number that succumbs to malaria, making it the fifth leading cause of deaths for under-fives. The disease was responsible for approximately 200,000 stillborn births in 2008, with another 91,000 neonatal deaths and another 151,000 children who survive infancy but still risk deformities or death. Treatment for congenital syphilis is simple – penicillin does the trick, administered either to the mother during pregnancy or to the child any time after birth. But there is no way to reverse whatever damage was already done before treatment. And few cases are detected and treated in low-income countries because awareness does not exist, diagnosis is poor, and the symptoms themselves often look like those of other diseases. Congenital syphilis is not prominent on the global health agenda because it is hard to describe, classify, and count in the usual categories of public health, which obscures the high morbidity and mortality associated with the disease. Congenital syphilis is not a priority disease globally and gets relatively little attention, yet exacts a considerable cost on vulnerable young lives.[ix]

Survival to the age of five is only the first hurdle. Malnourishment is pervasive, with vast impact. Nearly 870 million people worldwide are malnourished, and among them, more than 100 million children under five are considered underweight.[x] A diet lacking adequate vegetables, fruits and proteins has lifelong consequences. Between 250,000 and 500,000 children are considered to be at risk of becoming blind each year from Vitamin A deficiency, which could be easily remedied through access to leafy green vegetables.[xi]

Stunting – the condition of low growth where a child’s height falls far below standard measurements for his or her age -is estimated to affect as many as 28 per cent of children under five in low and middle-income countries - 162 million children in 2012. [xii] Stunted children often appear proportionately normal, but they are generally much smaller physically, and can suffer from both physical and mental development issues. Stunting starts before birth and is caused by poor maternal nutrition, poor feeding practices, poor food quality as well as frequent infections which can slow growth. Stunted children have weakened immune systems, and so are much more likely to contract serious illnesses. They are five times more likely to die from diarrhea than normally developed children. And the effects of stunting on mental and physical development are irreversible.[xiii]

Wasting, related to stunting, is where a child’s weight is far below standards for his or her height. In 2011 UNICEF identified 52 million children under five who were moderately or severely wasted. In South Asia up to 16 per cent of children fall into this category, more than 25 million of whom are in India..[xiv]

Both stunting and wasting are functions of acute or chronic malnutrition, which weakens immune systems and precludes normal development. The conditions replenish themselves: undernourished mothers are far more likely to give birth to stunted or wasted children, who, if they survive to maturity, perpetuate the cycle. These conditions are preventable through well-established interventions, including the improvement of women’s nutrition, early and exclusive breastfeeding, improved food security, and micronutrient supplements.[xv] A growing body of research in India has also demonstrated that adequate sanitation systems are essential to reducing exposure to bacteria and illness that keep even well-fed children malnourished because their compromised immune systems are working overtime.[xvi] But as effective as these steps might be, they have a narrow window. Once a child turns two, the impact of early malnutrition is most often irreversible.[xvii] This robs them of any chance of reaching their full intellectual, physical and social potential.